by William Taboas, M.A.
One of the aspects of Albert Ellis’ Rational Emotive Behavior Therapy (REBT) that got me hooked was the emphasis on clinically addressing complex negative emotions (e.g., embarrassment, jealousy, envy, shame, contempt) beyond the typical basic negative emotions (i.e., sadness, disgust, anger, and fear). In contemporary empirically-based interventions, complex emotions are rarely discussed, and in some cases, even deemphasized in the context of treatment delivery. While traditional forms of psychotherapy, literature, and theory have hinted about how complex emotional states contribute or maintain psychopathology, REBT is among the few empirically-based treatments that systematically addresses all unhealthy negative emotions in a clinical fashion.
Embarrassment, defined as a state of feeling foolish and experiencing intense discomfort with oneself, is often present in the therapy room. It is considered a self-conscious emotion, requiring higher cognitive processes such as self-reflection and self-evaluation. Its close relative, shame, is characterized by experiencing disgrace when the self or externally imposed standards are not met or a moral transgression has been committed. In contrast, embarrassment boils down to being in a state of displeasure with oneself after making a mistake considered a social faux-pas.
I believe the historical de-emphasis on clinically addressing embarrassment is due to clinical lore reinforcing that embarrassment is secondary to more functionally impairing emotions. However, REBT emphasizes the importance of addressing secondary disturbances or meta-disturbances. A secondary disturbance or meta-disturbance is defined as an emotional problem about an emotional or behavioral problem. Clients presenting to the therapy room might be thoroughly embarrassed with the issues they wish to work on, and may not be completely forthcoming about the details relevant to generating a comprehensive case conceptualization and treatment plan. Embarrassment also interferes with pursuing help from a professional. In other cases, embarrassment interferes with treatment delivery, and clients often face difficulties taking action that is necessary to achieve treatment goals.
Clients often describe that when their idealistic demands of “not making mistakes”, or “not acting foolish”, are not met, they often experience embarrassment. For example, while social anxiety is characterized by the physical and mental stress, apprehension, worry, and restlessness of being in the presence of others and fearing the consequences or negative evaluations, some clients report intolerance for potentially experiencing embarrassment as a primary drive to avoid social situations. In other cases, they might catastrophize about how foolish they will behave. I often hear the words uttered “it’s going to be awkward!”, or “I can’t stand the embarrassment!” leading to experiential and behavioral avoidance, and self-denigrating cognitions (e.g., “I am an embarrassment”) and behavior (e.g., using excessive self-deprecating humor). Potentially, symptoms of fear, anxiety, and depression are reinforced because of embarrassment.
Practitioners of REBT are very much in tune with secondary disturbances, and it may be clinically indicated to address these first, in order to successfully assist with the primary emotional disturbance. First, the therapeutic alliance needs to be built, emphasizing the need for rapport building and normalizing the clients’ experience. We then dispute the irrational beliefs (i.e., demands, catastrophizing/awfulizing, global self/other/world ratings, and frustration intolerance) related to embarrassment, with the aim of generating rational beliefs of being accepting of one’s nature as a fallible human being. After all, embarrassment can be fun too, and laughing at your mistakes and shortcomings while still working on them is a rational, and by consequence, functional alternative to self-downing.
I endorse the position that there should be continued need for assessing and addressing the full range of complex emotions that interfere with treatment. For now, your homework will be: assess how many times you experience embarrassment in a healthy manner where you laugh it off, or in an unhealthy manner, where embarrassment leads to avoidance and/or self-downing.
